Affordable Care Act and Changes for Clinicians
By Shirley Gentilini, MSW, LCSW
In March, I attended regional events celebrating Social Work Month. I neglected to acknowledge Paula March, LCSW, BCD, the social work awardee for Region H.
Region H Director Sara Cummings held a dinner at the Daily Grill in Santa Monica. She presented the Social Work Award to Paula March, LCSW, BCD. Paula’s colleagues, family and friends shared stories about her many accomplishments. As Paula spoke about her work, we could see why she was chosen for this award. Former social work awardees Karen Gilman (2012) and Val Vincent Reyes (2013) were also present.
Regional Alternative Director Jolene Hui and USC Student Liaison Jennifer Drew helped Sara with this event. Recent MSW graduates and NPN members were present and shared their pride and interest in their chosen profession. Again, the value of region and unit events is bringing experienced social work professionals and those new to the profession together.
The Affordable Care Act benefits mental health coverage by increasing access to Mental Health and Substance Abuse Disorders. This builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans. The ACA will expand insurance coverage to a projected 27 million Americans previously uninsured through access to private health insurance in the individual and small group markets, the Market Places and Medicaid.
Essential health benefits, including mental health and substance abuse disorders and services to parity requirements, will be available to this newly covered population. In total, through the Affordable Care Act, 32.1 million Americans will gain access to coverage that includes mental health and/or substance disorder benefits and an additional 30.4 million Americans who currently have some mental health and substance abuse benefits will benefit from the Federal Parity Protections. By building on the structure of the Mental Health Parity and Addiction Equity Act, the ACA will extend federal parity protection to 62 million Americans.
This newly acquired access to mental health services will mean employing additional mental health professionals. Social workers make up 45 percent of mental health providers in the United States. However social workers face a new challenge: a revised CMS-1500 form; the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM), which is used worldwide and copyrighted by the World Health Organization and maintained by (HHS); the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition,( DSM-5); and requirements to file quality measures from the Physician Quality Reporting System, (PQRS).
The DSM-5 will be implemented on October 1, 2014. The DSM-5 codes are harmonized with the ICD-10-CM codes. The mental health diagnostic codes will be included in the appendix section of the DSM-5 manual. The measure assessments in the DSM-5 assist in a comprehensive assessment of a patient and contribute to a diagnosis and treatment plan focused on the patient’s clinical presentation and context.
There are 15 new disorders with which clinical social workers should become familiar. To name a few — hoarding disorder, binge-eating disorder and cannabis withdrawal disorder. Mental retardation was replaced with the new term “intellectual disability or intellectual disorder (ID).”
For clinical social workers, the DSM-5 updates mental health coding and synchronizes the DSM-5 with the mental health coding in ICD-10-CM. The DSM-5 will be helpful in measuring the effectiveness of treatment a patient may require.
Another new challenge is the physician quality reporting initiative, now the Physician Quality Reporting System (PQRS). This consists of a set of health care measures which Medicare uses. Since January 1, 2014, clinical social workers must use the PQRS measures related to mental health when filing claims for Medicare patients. NASW has prepared a Practice Perspective on PQRS 2014. You can learn more about PQRS 2014, by downloading it at www.socialworkers.org/practice/clinical/2013.asp.
Our California chapter has workshops, seminars and websites where you can learn more about the new requirements and major changes in 2014 for clinical social workers. Also classes on the changes will be offered at the State Chapter Conference, in San Francisco in October 2014, and the National Conference in Washington, D.C. in July 2014.
NASW maintains its commitment to enhancing the well-being of people living with mental health conditions, and working toward increased access to appropriate services and interventions.
NASW is committed to improving mental health services and advocates for legislative action to improve the quality of care, access, reimbursement, research, and education in mental health. Mental Health Policy Statement, p.233 (Social Work Speaks, 9th Edition 2012-2014).
The Affordable Care Act is a step in the right direction to accomplish these goals.
